Provider Demographics
NPI:1588097836
Name:BROWN, TABETHA JAREL (APRN)
Entity type:Individual
Prefix:
First Name:TABETHA
Middle Name:JAREL
Last Name:BROWN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-2942
Mailing Address - Country:US
Mailing Address - Phone:918-649-0069
Mailing Address - Fax:918-649-0067
Practice Address - Street 1:210 W ROBERT ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2942
Practice Address - Country:US
Practice Address - Phone:918-649-0069
Practice Address - Fax:918-649-0067
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100665364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100665OtherAPRN LICENSE NUMBE